P0224 Learning Curve in Intestinal Ultrasound: Advancing from Basic Skills to Advanced Competencies – Insights from the IUS IG-IBD (Italian Group for the Study of Inflammatory Bowel Disease) Master Program
C Bezzio, D Pitoni, D G Ribaldone, M Vernero, F Castiglione, A Rispo, S Saibeni, G Maconi, F Terracciano, F Bossa, M Allocca, F Furfaro, E Calabrese, F Zorzi, M Fraquelli, F Caprioli, F Rizzello, E Mazzotta, A Orlando, M Grova, S Massironi, C Viganò, A ArmuzziAbstract
Background
Intestinal ultrasound (IUS) is increasingly used in assessing Crohn’s disease (CD) and ulcerative colitis (UC) due to its accessibility, low cost and absence of radiation. However, its operator dependency necessitates targeted training programs. This study aimed to evaluate the learning curve of gastroenterology trainees in IUS, determining the number of exams required to achieve diagnostic agreement with expert tutors.
Methods
This study was conducted at eight Italian referral centers for intestinal ultrasound as part of the IUS Master promoted by IG-IBD. Eight gastroenterology trainees with significant experience in abdominal ultrasound but limited exposure to IUS each performed 99 consecutive examinations. The trainees received an eight-hour course on IUS and one week of hands-on training with the expert sonographer. The exams were divided into three periods of 33. After each examination, an expert sonographer reassessed the findings and Cohen's Kappa coefficient was used to measure the agreement between the trainee and the expert operator for all the parameters considered. The parameters considered were bowel wall thickening, vascularity, Limberg score and complications (fistulas, stenosis, abscesses).
Results
A progressive improvement in concordance was observed across all parameters from period 1 to period 3 for all learners (Table 1). Overall agreement in identifying pathological findings increased from K=0.778 to K=0.911. Specifically, concordance for bowel wall thickening improved from K=0.558 in the first 33 exams to K=0.780 in later periods. Vascularity reached K=0.909 and the Limberg score achieved K=0.879. For complications, agreement on fistulas increased from K=0.765 to K=0.893, while stenosis improved from K=0.583 to K=0.872. Abscesses consistently demonstrated high concordance (K=0.855). The number of examinations required to achieve good agreement with the expert operator for detecting bowel wall thickening was at least 66, while 69 were needed for the accurate assessment of increased vascularity. However, detecting intra-abdominal complications required at least 99 examinations.
Conclusion
The time required to achieve proficiency in assessing intestinal ultrasound parameters related to the bowel wall is shorter than the time needed to detect the presence of complications. These findings highlight the importance of structured and supervised practice to achieve proficiency in both basic and advanced IUS competencies, providing a foundation for the development of standardized training programs in gastroenterology.